Keating Shelley E, de Boer Jack, Catsoulis Georgina, Stine Jonathan G, Goode Ana, Macdonald Graeme A, Powell Elizabeth, Hickman Ingrid J
School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA.
J Clin Transl Hepatol. 2025 Sep 28;13(9):707-722. doi: 10.14218/JCTH.2025.00155. Epub 2025 Aug 21.
Regular exercise is fundamental for people with metabolic dysfunction-associated steatotic liver disease (MASLD), yet exercise maintenance is generally poor. This generative co-design process aimed to embed the voices and opinions of people with lived experience of MASLD and their care stakeholders to (i) frame barriers and enablers to exercise maintenance and (ii) highlight priorities for exercise-focused research agendas in MASLD.
A generative co-design framework was applied. Two virtual co-design sessions were undertaken: - , where initial discovery was conducted with people with lived experience of MASLD; and - with lived experience partners and healthcare stakeholders. Sessions were audio-recorded and transcribed, and key determinants and considerations were discerned by two independent researchers.
Lived experience partners (n = 5, 53 ± 16 years, 40% male) ranked five equally important barriers to exercise maintenance: musculoskeletal and pain issues, lack of access to exercise equipment/facilities, cost, competing priorities, and low energy levels, which influenced core positive and negative determinants. Alongside lived experience partners, healthcare stakeholders (hepatologists [n = 3], exercise professionals [n = 3], 67% male) identified three core needs with eight considerations. Some disconnects in priorities were observed. Lived experience partners emphasized affordability, accessibility, and considerations for comorbidities, while healthcare partners advocated for research on natural history, prevention, behavior change, cost-effectiveness, and health system change.
This co-design methodology highlights unique consumer-informed research questions. Exercise interventions and their associated implementation trials will benefit from being co-designed with both people with MASLD and care stakeholders.
规律运动对于代谢功能障碍相关脂肪性肝病（MASLD）患者至关重要，但运动坚持情况普遍较差。这一生成性协同设计过程旨在纳入有MASLD生活经历的患者及其护理利益相关者的声音和意见，以（i）界定运动坚持的障碍和促进因素，以及（ii）突出MASLD中以运动为重点的研究议程的优先事项。
应用了生成性协同设计框架。开展了两次虚拟协同设计会议：一次是与有MASLD生活经历的患者进行初步探索；另一次是与有生活经历的伙伴和医疗保健利益相关者进行会议。会议进行了录音和转录，两名独立研究人员辨别出关键决定因素和考虑因素。
有生活经历的伙伴（n = 5，年龄53±16岁，40%为男性）将运动坚持的五个同等重要的障碍列为：肌肉骨骼问题、缺乏运动设备/设施、成本、相互竞争的优先事项以及精力水平低，这些因素影响了核心的积极和消极决定因素。除了有生活经历的伙伴，医疗保健利益相关者（肝病专家[n = 3]、运动专业人员[n = 3]，67%为男性）确定了三个核心需求及八个考虑因素。在优先事项方面存在一些脱节。有生活经历的伙伴强调可承受性、可及性以及对合并症的考虑，而医疗保健伙伴则主张对自然史、预防、行为改变、成本效益和卫生系统变革进行研究。
这种协同设计方法突出了基于消费者的独特研究问题。运动干预及其相关的实施试验将受益于与MASLD患者和护理利益相关者共同设计。
